Evaluation Of Left Ventricular Diastolic Dysfunction Research Articles

Evaluation of LVDD by CCTA with Dual-source CT in Type 2 Diabetes Mellitus Patients.

Left ventricular diastolic dysfunction (LVDD) is a common abnormality among patients in T2DM. We aimed to evaluate the feasibility of coronary computed tomography angiography (CCTA) for the assessment of LVDD in type 2 diabetes mellitus (T2DM) patients. 80 consecutive T2DM patients who were referred for a clinically dual-source CCTA examination to evaluate suspected coronary artery disease and also underwent 2D echocardiography within 7 days of CCTA inclusion and exclusion criteria, were performed. Correlation between CCTA and echocardiography was tested through linear regression and Bland-Altman analysis. In total, 60 T2DM patients were included for the analysis. Pearson correlation showed good correlation for E (r = 0.28; P = 0.028), E/A (r = 0.69; P < 0.01); E (r = -0.06; P = 0.776), E/A (r = 0.54; P = 0.003) and E (r = 0.64; P < 0.01), E/A (r = 0.83; P < 0.01) in three groups, respectively. Overall, diagnostic accuracy for assessment in CCTA of diastolic dysfunction was 79.76% (95% CI: 68%-91%), 71.43% (95% CI: 58%-85%) and 87.50 (95% CI: 79%-96%) in three groups. The presented study proved that CCTA showed good correlations in the estimation of LV filling pressures compared with echocardiography in T2DM patients. Accordingly, retrospectively ECG-gated CCTA may provide valuable information on the evaluation of LVDD in T2DM patients.

Preoperative Left Ventricular Diastolic Dysfunction Is Associated with Pulmonary Edema after Carotid Endarterectomy.

This retrospective study was aimed to investigate the association between preoperative left ventricular (LV) cardiac function and the incidence of postoperative pulmonary edema (PE) in patients undergoing carotid endarterectomy (CEA). Most patients undergoing CEA for carotid artery stenosis have concomitant heart diseases, leading to hemodynamic instability that can cause postoperative cardiac complications such as cardiac heart failure. LV diastolic function has recently been recognized as an independent predictor of adverse cardiac events in patients undergoing cardiovascular surgery. We analyzed clinical data from the anesthetic and medical records of 149 consecutive patients who underwent CEA at our university hospital between March 2012 and March 2018. LV systolic and diastolic function were evaluated by ejection fraction and the ratio of LV early diastolic filling velocity to the peak velocity of mitral medial annulus (E/e′). Postoperative PE was diagnosed based on chest X-ray and arterial gas analysis by two independent physicians. Postoperative PE was developed in four patients (2.8%). Patients with postoperative PE were not related to preoperative low ventricular ejection fraction, but had a significantly higher E/e′ ratio than those without PE (P = 0.01). Furthermore, there was an increasing trend of PE according to the E/e′ category. Preoperative LV diastolic function evaluated by E/e′ was associated with the development of postoperative PE in patients who underwent CEA. The results suggest that the evaluation of LV diastolic dysfunction could be possibly useful to predict PE in patients undergoing CEA.

Sex Differences in the Relationship Between Left Ventricular Diastolic Dysfunction and Coronary Artery Disease: From the Korean Women's Chest Pain Registry.

Although coronary artery disease (CAD) is an important comorbidity, the influence of CAD on left ventricular diastolic dysfunction (LVDD) is not clear. This study aims to assess differences in the relationship between CAD and LVDD according to sex and comorbidities. A total of 1109 consecutive patients who visited an outpatient clinic with chest pain were included. The outcomes in 295 men and 295 women were compared after propensity score 1:1 matching. The evaluation of LVDD was based on guidelines recommended by the American Society of Echocardiography. The presence and severity of obstructive CAD was assessed by coronary angiography. After propensity score matching, both men and women were well balanced, with no significant differences of baseline covariates. Differences in diastolic functional parameters according to CAD severity were observed only in women (three parameters of LVDD except e' velocity, p < 0.05). Multiple logistic regression for matched pair data demonstrated that CAD severity was associated with the presence of LVDD only in women (odds ratio 1.919, 95% confidence interval 1.343-2.741, p < 0.001). Interaction between sex and severity of CAD was significant (p = 0.025). The association of LVDD and CAD severity was observed only in women. Myocardial ischemia may be a potential pathophysiology for higher prevalence of LVDD and heart failure with preserved ejection fraction in women.

Left atrial minimum volume by real-time three-dimensional echocardiography as an indicator of diastolic dysfunction

Background Left atrial (LA) maximum volume is becoming a prognostic biomarker for left ventricular (LV) diastolic dysfunction. However, we assessed LV diastolic function by measuring LA phasic volumes using real-time three-dimensional echocardiography (RT3DE) in patients with stable coronary artery disease (CAD). Methods Sixty-five stable CAD patients with normal LV ejection fraction (LVEF) were divided into three groups according to degree of coronary stenosis: control (n=15) with &lt;50% stenosis as control group, mildS (n=25) with mild stenosis (50%-70%) and severeS (n=25) with &gt;70% stenosis. LA phasic volumes and function were evaluated and compared using RT3DE and two dimensional echocardiography (2DE). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were examined. The correlations of RT3DE-derived parameters with other conventional indices were analyzed. Results Significant correlations between RT3DE and 2DE for LA volume measurements were: control, r=0.93; mildS, r=0.94; severeS, r=0.90 (all P &lt;0.05). Patients with severe coronary stenosis presented higher NT-proBNP level, indices of LA minimum volume and volume before atrial contraction, but lower LA total emptying fraction (LAEF) and LAEFpassive. Significant correlations of RT3DE derived LA volume indices with E/E' (r=0.695) and NF-proBNP (r=0.630) level were found. Conclusions RT3DE derived, LA indices correlate well with NT-proBNP level and may be superior to 2DE measurements for the evaluation of LV diastolic dysfunction. Enlargement of LA minimum volume in stable CAD patients without systolic dysfunction appears earlier and may be better correlated with LV diastolic function than that of LA maximum volume.

Clinical Significance of Positive Isovolumetric Relaxation Velocity of Pulsed‐Wave Tissue Doppler Imaging

Among the pulsed-wave tissue Doppler imaging (pw-TDI) parameters, there are two different pw-TDI velocities (IVRa and IVRb) after systolic velocity, but before Ea velocity. In our study, we investigated the clinical importance of these two velocities in left ventricular diastolic dysfunction (LVDDF) evaluation. One hundred and eighty cases without exclusion criteria were included in the study. Cases with a transmitral E to A flow (E/A) ratio below 1 were assigned to group 2. In cases with an E/A ratio between 1 and 2, the pw-TDI parameters were taken into consideration. Cases with an Ea/Aa ratio above 1 were assigned to group 1 and cases with an Ea/Aa ratio 1 or below than 1 were assigned to group 3. Group 1 (n: 68) represented normal diastolic left ventricular (LV) inflow while group 2 (n = 87) represented impaired relaxation and group 3 (n = 25) represented pseudonormal LV inflow. In our study, we found that IVRa velocity was lower in group 1 compared to group 2 and group 3 (P < 0.001 and P = 0.038, respectively). Similarly, this velocity was significantly different in group 3 and group 2 such as it was higher in group 2 compared to group 3 (P = 0.022). There was no difference in IVRb velocity and IVRa/IVRb ratio among the groups. A negative correlation was found between IVRa velocity and Ea velocity (r = 44%, P < 0.001). Positive correlation was found between IVRa velocity and isovolumetric relaxation time (r = 18%, P = 0.014) and also between IVRa velocity and Aa velocity (r = 19%; P = 0.010). Based on the results of our study, we concluded that IVRa velocity is an important pw-TDI parameter in the evaluation of LVDDF, especially in differentiating pseudonormal LVDDF type from normal LV inflow.

M-mode analysis of mitral annulus motion for detection of pseudonormalization of the mitral inflow pattern

Left ventricular (LV) diastolic dysfunction is a frequent cause of heart failure. Doppler echocardiography has become the method of choice for the noninvasive evaluation of LV diastolic dysfunction. However, pseudonormalization of mitral inflow often presents a diagnostic problem in clinical practice. We sought to define the role of mitral annulus motion in this setting. We performed echocardiography in 36 consecutive subjects (age 59 ± 10 years). Eighteen had recently (within 3 months) been diagnosed with coronary artery disease, 18 had clinical suspicion of coronary artery disease, and 15 had symptoms of heart failure (New York Heart Association class 2.4 ± 0.5). The amplitude (E M) and the slope (slope E) of early diastolic motion of the septal mitral annulus were derived from M-mode analysis. Left heart catheterization was performed for direct measurement of LV end-diastolic pressure. Pseudonormalization defined by an E/A ratio >1 and a LV end-diastolic pressure ≥16 mm Hg was found in 9 patients. All patients with pseudonormalization were symptomatic (New York Heart Association class 2.8 ± 0.5). Patients with and without pseudonormalization did not differ with respect to the E/A ratio (1.29 ± 0.44 vs 1.16 ± 0.23, p = NS), deceleration time (182 ± 38 vs 205 ± 42 ms, p = NS), and isovolumic relaxation time (88 ± 24 vs 92 ± 18 ms, p = NS). In the group with pseudonormalization, a significant reduction of E M (3.9 ± 1.6 vs 5.7 ± 1.5 mm, p = 0.008) and slope E (24.5 ± 11.8 vs 43.9 ± 7.7 mm/s, p <0.001) was detected. Using E M <4.3 mm and slope E <35 mm/s as cut points, sensitivity and specificity for the detection of pseudonormalization were 66% and 82% for E M and 77% and 87% for slope E, respectively. There was no significant relation between LV end-diastolic pressure as a measure of preload and either E M (r = 0.44, p >0.5) or slope E (r = 0.30, p >0.2). Thus, E M and slope E may be preload-independent tools for assessing LV diastolic dysfunction in symptomatic patients with a pseudonormal mitral inflow pattern and elevated filling pressures.